Abstract
Purpose
To compare self-reported joint status, quality of life, level of activity and pain management in patients scheduled for surgical treatment of seven common ankle disorders: osteoarthritis (OA), primary osteochondral lesion of talus (P-OLT), recurrent osteochondral lesion of talus (R-OLT), lateral ankle instability (INST) and anterior (ANT-IMP), posterior (POST-IMP) and combined (COMB-IMP) ankle impingements.
Methods
The cross-sectional study design was implemented. Hospital records of 610 patients that were admitted for surgical intervention on the ankle joint over a seven year period were reviewed. Patient selection (over 18 years, no systemic musculoskeletal illnesses, only one isolated ankle pathology) resulted in 123 eligible patients for current study (OA 22, P-OLT 19, R-OLT 18, INST 15, ANT-IMP 20, POST-IMP 13, COMB-IMP 16). Foot and Ankle Outcome Score (FAOS), European quality of life in a visual analogue and in five dimensions (EQ-VAS, EQ-5D-3L), Tegner activity scale (TAS) and pain medication usage were recorded at the admission and compared across these seven groups.
Results
All evaluated ankle disorders induced the following: (a) subjective joint-specific dysfunction - FAOS cumulative: 42 (OA), 50 (R-OLT), 65 (P-OLT), 65 (INST), 63 (ANT-IMP), 61 (POST-IMP), 60 (COMB-IMP); (b) decreased quality of life - EQ-5D-3L: 0.41 (OA), 0.44 (R-OLT), 0.56 (P-OLT), 0.62 (INST), 0.64 (ANT-IMP), 0.56 (POST-IMP), 0.60 (COMB-IMP) and (c) decreased activity level - TAS: 2.1 (OA), 2.7 (R-OLT), 3.7 (P-OLT), 4.0 (INST), 4.7 (ANT-IMP), 4.4 (POST-IMP), 5.1 (COMB-IMP). FAOS subscales, EQ-5D-3L and TAS were significantly lower in OA and R-OLT patients. Between 31% (POST-IMP) and 68% (OA and R-OLT) of patients required pain medication over one month prior to the assessment.
Conclusion
All analysed ankle disorders in patients amenable for surgical treatment induced a considerable decline in patients` perceived ankle function, quality of life and activity level. The worst subjective ankle status was reported equally by OA and R-OLT patients, while patients with the other five disorders reported comparable values.
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Data availability
Raw data (clinical, radiography) were generated at the University Medical Centre Ljubljana, Slovenia. Derived anonymized data supporting findings of this study are available from the corresponding author upon request.
References
Trč T, Handl M, Havlas V (2010) The anterior talo-fibular ligament reconstruction in surgical treatment of chronic lateral ankle instability. Int Orthop 34(7):991–996. https://doi.org/10.1007/s00264-010-0995-7
Hintermann B, Boss A, Schäfer D (2002) Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 30(3):402–409. https://doi.org/10.1177/03635465020300031601
van Dijk CN, Vuurberg G (2017) There is no such thing as a simple ankle sprain: clinical commentary on the 2016 International Ankle Consortium position statement. Br J Sports Med 51(6):485–486. https://doi.org/10.1136/bjsports-2016-096733
Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806. https://doi.org/10.1007/s11999-008-0543-6
Thomas MJ, Roddy E, Zhang W, Menz HB, Hannan MT, Peat GM (2011) The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain 152(12):2870–2880. https://doi.org/10.1016/j.pain.2011.09.019
Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Årøen A (2010) Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 38(2):231–237. https://doi.org/10.1177/0363546509352157
Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22(10):788–794. https://doi.org/10.1177/107110070102201004
Rabin R, Charro FD (2001) EQ-SD: a measure of health status from the EuroQol Group. Ann Med 33(5):337–343. https://doi.org/10.3109/07853890109002087
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Golightly YM, DeVellis RF, Nelson AE, Hannan MT, Lohmander LS, Renner JB, Jordan JM (2014) Psychometric properties of the foot and ankle outcome score in a community-based study of adults with and without osteoarthritis. Arthritis Care Res 66(3):395–403. https://doi.org/10.1002/acr.22162
Rupel VP, Srakar A, Rand K (2019) Valuation of EQ-5D-3l health states in Slovenia: VAS based and TTO based value sets. Slov J Public Health 59(1):8–17. https://doi.org/10.2478/sjph-2020-0002
Zrubka Z, Beretzky Z, Hermann Z, Brodszky V, Gulácsi L, Rencz F, Baji P, Golicki D, Rupel VP, Péntek M (2019) A comparison of European, Polish, Slovenian and British EQ-5D-3L value sets using a Hungarian sample of 18 chronic diseases. Eur J Health Econ 20(1):119–132. https://doi.org/10.1007/s10198-019-01069-8
Halasi T, Kynsburg Á, Tállay A, Berkes I (2004) Development of a new activity score for the evaluation of ankle instability. Am J Sports Med 32(4):899–908. https://doi.org/10.1177/0363546503262181
Matheny L, Clanton T, Gittner K, Harding J (2018) Normative values for commonly reported outcome measures in the foot and ankle. Foot Ankle Orthop 3(2):2473011418S00011. https://doi.org/10.1177/2473011418S00011
Briggs KK, Steadman JR, Hay CJ, Hines SL (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37(5):898–901. https://doi.org/10.1177/0363546508330149
Neogi T (2013) The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil 21(9):1145–1153. https://doi.org/10.1016/j.joca.2013.03.018
Porter M, Shadbolt B, Ye X, Stuart R (2019) Ankle lateral ligament augmentation versus the modified Broström-Gould procedure: a 5-year randomized controlled trial. Am J Sports Med 47(3):659–666. https://doi.org/10.1177/0363546518820529
Zwiers R, Wiegerinck JI, Murawski CD, Fraser EJ, Kennedy JG, van Dijk CN (2015) Arthroscopic treatment for anterior ankle impingement: a systematic review of the current literature. Arthroscopy 31(8):1585–1596. https://doi.org/10.1016/j.arthro.2015.01.023
Lee KB, Bai LB, Chung JY, Seon JK (2010) Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18(2):247–253. https://doi.org/10.1007/s00167-009-0914-x
Yoon HS, Park YJ, Lee M, Choi WJ, Lee JW (2014) Osteochondral autologous transplantation is superior to repeat arthroscopy for the treatment of osteochondral lesions of the talus after failed primary arthroscopic treatment. Am J Sports Med 42(8):1896–1903. https://doi.org/10.1177/0363546514535186
Havelin J, King T (2018) Mechanisms underlying bone and joint pain. Curr Osteoporos Rep 16(6):763–771. https://doi.org/10.1007/s11914-018-0493-1
Choi WJ, Jo J, Lee JW (2013) Osteochondral lesion of the talus: prognostic factors affecting the clinical outcome after arthroscopic marrow stimulation technique. Foot Ankle Clin 18(1):67–78. https://doi.org/10.1016/j.fcl.2012.12.004
Kamrad I, Carlsson Å, Henricson A, Magnusson H, Karlsson MK, Rosengren BE (2017) Good outcome scores and high satisfaction rate after primary total ankle replacement: 167 patients followed for 24 months in the Swedish Ankle Registry. Acta Orthop 88(6):675–680. https://doi.org/10.1080/17453674.2017.1366405
Maher AJ, Kilmartin TE (2012) An analysis of Euroqol EQ-5D and Manchester Oxford Foot Questionnaire scores six months following podiatric surgery. J Foot Ankle Res 5(1):17. https://doi.org/10.1186/1757-1146-5-17
Scholten PE, Sierevelt IN, Van Dijk CN (2008) Hindfoot endoscopy for posterior ankle impingement. J Bone Joint Surg 90(12):2665–2672. https://doi.org/10.2106/JBJS.F.00188
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The study was funded by the University Medical Centre Ljubljana - institutional research funding grant #20190041 to MD.
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The investigational plan was approved by the National Medical Ethics Committee (No. 0120-99/2019/4). This study was part of a larger research project registered at ClinicalTrials.gov: NCT04132076.
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Kolar, M., Brulc, U., Stražar, K. et al. Patient-reported joint status and quality of life in sports-related ankle disorders and osteoarthritis. International Orthopaedics (SICOT) 45, 1049–1055 (2021). https://doi.org/10.1007/s00264-020-04747-y
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DOI: https://doi.org/10.1007/s00264-020-04747-y